American Indians (AI) have the highest rates of smoking of any racial/ethnic group in the US (41% versus 23% for whites and blacks). Consequently, they suffer the highest mortality from tobacco-related illnesses of any racial/ethnic group; two of every five AI die from a tobacco-related illness. AI youth have a high prevalence of tobacco use as well, where cigarette smoking is reported just below 37% for youth aged 11-18. Tobacco prevention efforts include education materials and programming that deter individuals from starting smoking or encourage individuals to quit smoking. However, we do not know if education efforts are fully understood and resonate with target populations, as indicated by high prevalence rates among AI populations. This may be explained, in part, because tobacco is a sacred plant to many AI and, as such, cannot be treated completely negatively, as most primary and secondary prevention programs do. We propose to create health literacy (HL) instrument that is specific to tobacco knowledge and risk. We believe this is a necessary step in primary and secondary prevention efforts in order to determine the appropriate way to intervene upon behaviors among those who have yet to start smoking, those who smoke and want to quit, and those that smoke and do not want to quit. Therefore, our long-term goal is to improve tobacco education and programming that will lead to better tobacco prevention efforts among AI communities. Our team has successfully used community-based participatory research (CBPR) to address tobacco use with AI communities since 2003. Our community partners requested that we examine additional ways to improve tobacco prevention efforts. We will address the following specific aims: (1) Develop a HL measure that is specific to tobacco use among AI populations by using CBPR to create a culturally relevant instrument that examines tobacco HL knowledge and risk; (2) Determine the reliability and validity of a tobacco HL measure among AI populations by testing it with AI adults (long form, n=250; short form, n=100). We will use experts to estimate content validity and factor analysis on participants' responses to estimate instrument's dimension and reliability. Our rationale for this project is tha the use of a tobacco HL instrument will lead to the design of better primary and secondary prevention tools, thus reducing tobacco-related disparities.